Jaundice & Abnormal Liver Function Tests
Syndromes that result in unconjugated hyperbilirubinemia (indirect bilirubin)
Gilbert Syndrome and Crigler-Najjar Syndrome - Impaired bilirubin uptake and storage problem
Four most common causes of cirrhosis
Alcohol, chronic hepatitis C infection, NAFLD, and hepatitis B infection
Disease that occurs in middle-aged women. Elevated Alk phos, positive antimitochondrial antibodies, elevated IgM, increased cholesterol
Primary Biliary Cholangitis
Symptoms associated with severe right hypochondrium or epigastrium, nausea and vomiting, fever and leukocytosis.
Acute cholecystitis
Symptoms associated with chronic pancreatitis
Chronic intermittent epigastric pain, steatorrhea, weight loss, abnormal pancreatic imaging
Syndromes that result in conjugated hyperbilirubinemia (direct bilirubin)
Dubin-Johnson Syndrome and Rotor Syndrome- Problem of faulty excretion of bilirubin conjugates.
Three principal causes of NAFLD
Obesity, diabetes mellitus, and hypertriglyceridemia
Disease characterized by elevated iron saturation or serum ferritin. Asymptomatic until fifth decade of life typically.
Hemochromatosis
Choledocholithiasis
Predisposing factors of chronic pancreatitis
TIGAR-O: toxic metabolic, idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis, or obstructive.
Causes of ALT elevations (<5 x normal)
Chronic hepatitis B, C, and D, acute viral hepatitis, steatosis, hemochromatosis, autoimmune hepatitis, Alpha-1-antitrypsin deficiency, Wilson disease, Celiac Disease.
Treatment for Autoimmune Hepatitis
Prednisone with or without azathioprine. In patients with noncirrhotic autoimmune hepatitis, budesonide may be as effective as prednisone.
Autosomal recessive disorder occurring under the age of 40. Characterized by deposition of copper in the liver and brain. Serum ceruloplasmin is low. Urinary excretion of copper and hepatic copper concentration are high.
Wilson Disease
Disease associated with a high risk of gallbladder cancer
Porcelain gallbladder
Name the criteria used to assess severity of acute pancreatitis
Ranson criteria
Causes of AST elevations (<5 x normal)
Alcohol-related liver injury, Cirrhosis, Covid-19
What is the most common cause of acute liver failure?
Toxicity from acetaminophen overdose (accounting for at least 45% of cases).
Disease associated with RUQ pain and ascites. Imaging shows occlusion of flow in the haptic veins or inferior vena cava.
Hepatic Venous Outflow Obstruction or Budd-Chiari Syndrome
Components of Charcot Triad and Reynolds pentad
RUQ pain, fever/chills, and jaundice
Altered mental status and hypotension make the pentad.
Causes of pancreatitis
Biliary tract disease (45%), heavy alcohol use (20%) two most common followed by HLD, hypercalcemia, abdominal trauma, medications, vasculitis, infections.
Smoking, high dietary glycemic load, and abdominal fat increase risk of pancreatitis as well as older age. I
Non-hepatic causes of elevated aminotransferases (<5 x normal)
Sternuous exercise, hemolysis, myopathy, thyroid disease.
Name the five hepatic viruses
hepatitis A, B, C, D, and E
Name two benign liver neoplasms associated with contraception use in women.
Cavernous hemangioma and Hepatocellular adenoma.
Disease found most often in men in mid-life, associated with ulcerative colitis, progressive jaundice, itching. At least 10% risk of cholangiocarcinoma
Vegetable consumption, dietary fiber, and use of statins may reduce risk of pancreatitis.
Coffee drinking may reduce risk of non-biliary pancreatits.